title: Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome.
abstract: BACKGROUND
  The prognostic value of ECG-gated rest 201Tl/stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of acute coronary syndrome (ACS: myocardial infarction (MI) and unstable angina (UA)) and the implications of ejection fraction (EF) has not yet been defined in Japanese.
  
  
  RESULTS
  The 1,895 patients were followed up for the occurrence ACS. The mean follow-up interval was 26.9+/-15.5 months. The 142 patients with revascularization within 60 days were censored. Summed stress score (SSS) and summed difference score (SDS) were calculated. The 19 MI and 29 UA occurred (1.1% and 1.6%, respectively). Univariate Cox analysis showed that hypertension (Wald 5.09, p<0.05), poststress EF (Wald 10.9, p<0.01), SSS (Wald 12.4, p<0.001) and SDS (Wald 18.7, p<0.001) were significant predictors of ACS. Multivariate Cox analysis showed that hypertension (Wald 4.27, p<0.05) and SDS (Wald 8.59, p<0.01) were independent predictors. When multiple clinical risk factors (number of coronary risk factors > or =2), significant ischemia (SDS > or =4) and low EF (EF <45%) were applied to multivariate Cox analysis, the combination of significant ischemia and low EF showed the highest predictive value (Wald 11.9; p<0.001) for future ACS.
  
  
  CONCLUSIONS
  Poststress EF added incremental prognostic value for the prediction of ACS.
authors.affiliation: Department of Cardiology, Nihon University School of Medicine, Tokyo.
authors.forename: Naoya
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Shu
authors.initials: S
authors.lastname: Kasama
authors.forename: Yoshimochi
authors.initials: Y
authors.lastname: Nakano
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kato
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yoda
authors.forename: Takaaki
authors.initials: T
authors.lastname: Miki
authors.forename: Jun
authors.initials: J
authors.lastname: Iida
authors.forename: Taeko
authors.initials: T
authors.lastname: Kunimasa
authors.forename: Futoshi
authors.initials: F
authors.lastname: Tadehara
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D000255:Adenosine Triphosphate; D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C078700:technetium tc-99m tetrofosmin; D000255:Adenosine Triphosphate